Key result
Cardiac catheterization in nonagenarians is linked to ~13% in-hospital mortality, reflecting higher baseline comorbidities.
Why the study?
Does cardiac catheterisation in patients ≥ 90 years of age result in acceptable in-hospital mortality and complications compared to younger patients?
Cohort (n=32)
No
Does cardiac catheterisation in patients ≥ 90 years of age result in acceptable in-hospital mortality and complications compared to younger patients?
Cardiac catheterisation in nonagenarians is associated with higher in-hospital mortality than in younger patients, but the risk is considered acceptable given their higher baseline comorbidities and acute presentations.
Answers are grounded in this paper and cite their sources.
Higher mortality in nonagenarians warrants individualized selection; leaves open net benefit versus younger patients.
OBJECTIVE: To explore the treatment, procedure related risks, and outcomes of patients older than 90 years of age undergoing cardiac catheterization. METHODS: We retrospectively studied 32 patients ≥ 90 years (93.0 ± 1.2 years) who underwent cardiac catheterisation in a tertiary specialist hospital (0.2% of 14,892 procedures during three years). The results were compared to a patient cohort younger than 90 years of age. RESULTS: Baseline characteristics revealed a higher prevalence of diabetes (P < 0.001), chronic obstructive pulmonary disease (P < 0.04), previous myocardial infarction (P < 0.02), and complex coronary anatomy (SYNTAX score 33 vs. 19) in nonagenarians. Patients < 90 years of age showed more hyperlipidemia (P < 0.01) and previous percutaneous coronary interventions (P < 0.015). Nonagenarians underwent coronary angiography more often for acute coronary syndrome (ACS) (P < 0.003), were presented more often in cardiogenic shock (P < 0.003), and were transferred faster to coronary angiography in cases of ACS (P < 0.0001). The observed in-hospital mortality rate (13% study group vs. 1% control group; P < 0.003) in nonagenarians was lower than the calculated rate of thrombolysis in myocardial infarction (TIMI) and global registry of acute cardiac events (GRACE) mortality and strongly influenced by the severity of clinical presentation and the presence of co-morbidities. CONCLUSION: Despite the common scepticism that cardiac catheterisation exposes patients ≥ 90 years to an unwarranted risk, our data demonstrate an acceptable incidence of complications and mortality in this group of patients.
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Ohlow et al. (2012) conducted a cohort in Undergoing cardiac catheterisation (n=32). Cardiac catheterisation at age ≥ 90 years vs. Cardiac catheterisation at age < 90 years was evaluated on In-hospital mortality rate (p=< 0.003). Cardiac catheterisation in patients ≥ 90 years was associated with a 13% in-hospital mortality rate compared to 1% in younger patients, reflecting higher baseline comorbidities.
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